Time to Update the Mental Health Services Act

Economic Outlook Remains Positive, But Homeless Numbers Increase.

Time to Update the Mental Health Services Act

November 23, 2015

Last week two very important sets of numbers were released showing the disconnect between a healthy economy and the status of people who need behavioral health services.

The state’s Legislative Analyst presented an updated state budget forecast showing that state revenues will exceed the budget estimates by $3.5 billion for this year, a growing surplus for next year and for the next several years.

This is consistent with trends in reports we have provided showing significantly increased revenues for county behavioral health authorities. However, as we have reported in the past these revenue increases have not translated into expansion of services in very many counties. We noted that most counties had discontinued homeless outreach services during the recession and very few had restarted them in spite of two very good years of revenue growth with more forecast for next year.

That pattern is now reinforced by new homeless data showing that homeless numbers in California had risen over the past few years and we know that most of the homeless have significant behavioral health challenges and that chronic homelessness is almost always due to an untreated behavioral health condition (usually co-occurring mental health and chemical dependency).

Continue reading Time to Update the Mental Health Services Act

12 Months of Planning for Biggest Changes in Decades

November 16, 2015

  • Opportunities and challenges for counties and providers
  • New Alcohol and Drug Organized Delivery System
  • CCBHC/Excellence in Mental Health Act Certification and PPS
  • Whole Person Healthcare Integration Pilots under Section 1115 Waiver

All of these issues have to be addressed in the coming year by counties and providers.

When I speak with community behavioral health agencies, the biggest issue for most seems to be the lack of contract expansion and the frustration that counties don’t seem to make that a very high priority and claim that they don’t have the significant growth in revenues that all of the state revenue charts indicate they have received or soon will receive.

Continue reading 12 Months of Planning for Biggest Changes in Decades

Department of Finance provides MHSA estimates for next four years

Department of Finance provides MHSA estimates for next four years – modest continued growth forecast to bring total to nearly $2 Billion

Last month I reported that two newspaper stories indicated that counties had hundreds of millions of dollars in unspent MHSA funds above their prudent reserve for the inevitable eventual economic downturn.

CBHDA had responded by indicating that counties considered this to be one time funding created by a spike in MHSA revenues which would not be sustained. This suggested that counties believed that MHSA revenues would go down in the next years and so I asked the state department of finance if they could take their multi year estimates of state income tax revenues and do similar estimates for MHSA revenues. Continue reading Department of Finance provides MHSA estimates for next four years

Early Psychosis Programs – taking it to scale

Early psychosis programs began about 20 years ago in Melbourne Australia led by a psychiatrist who observed data showing that there was an incredibly greater recovery rate among those people with schizophrenia who were first seen within a few months after the onset of psychosis.

Their program demonstrated that for that population they were able to achieve a success rate of 80% being discharged from the intensive treatment program to medication only after 18 months and full time employment or education as compared to a success rate of only about 20% for people for whom treatment is delayed for more than a year after the initial experience of psychosis.

This success has generally been replicated in other programs. Until recently, nearly all such programs were small “pilot” programs including about a dozen funded by the MHSA in California.

Continue reading Early Psychosis Programs – taking it to scale

Closing the Gaps and Disparities in Continuity of Care

Closing the Gaps and Disparities in Continuity of Care

Actions and discussions this year indicate a serious effort on the  part of state leaders and interest groups to address one of the remaining major disparities affecting behavioral healthcare which is the lack of a commitment to continuity of care that is much more prevalent in attending to purely physical health conditions. Continue reading Closing the Gaps and Disparities in Continuity of Care

Time to adjust California’s Mental Health Services Act


July 2015 Blog – Data shows wide disparities among counties and ethnicities

Data shows wide disparities among counties and ethnicities

Will Data Drive Policy?

CCCMHA has had the support of a summer intern, Chelsea Parker, who compiled data about MediCal penetration rate among counties age groups and ethnicities and also developed reports about how readily different populations access mental health services. Continue reading July 2015 Blog – Data shows wide disparities among counties and ethnicities

June 2015 Blog – Excellence in Mental Health Act – Certified Community Behavioral Health Centers

Excellence in Mental Health Act – Certified Community Behavioral Health Centers

State Preparation for Planning Grant- to compete for increased federal funds

The biggest federal investment in community behavioral health is  buried in a little-known provision in a federal law known as the Protecting Access to Medicare Act of 2014. This law authorizes SAMHSA (the federal Substance Abuse and Mental Health Services Administration) to designate eight states to receive a 15% increase in their federal share of costs for outpatient behavioral health care for two years through designation of certified community behavioral health centers (CCBHCs). The law is also known as the Excellence in Mental Health Act which is the term still preferred by its sponsoring members of Congress (including California’s Doris Matsui) and lead advocacy organization the National Council for Behavioral Health. Continue reading June 2015 Blog – Excellence in Mental Health Act – Certified Community Behavioral Health Centers

May 2015 Blog – Governor’s May Budget Revise – First Takes

Governor’s May Budget Revise – First Takes

Surprising lack of increase in Mental Health Services Act Revenues – No major changes in health and behavioral health programs. Earned Income Tax Credit for poor is major non education new program.

On May 14th, Governor Brown released his May Revise to his proposed state budget for the 2015-16 fiscal year. It has been widely reported that state revenues are running way above CCCMHA_63_logoprojections and that most of the new money would go to schools. The May Revise confirmed both of those forecasts but surprisingly there was no forecasted increase in revenues from the Mental Health Services Act.

We really have no explanation for this. We have asked the State Department of Finance how it can be true that overall income tax revenues are 5% above January forecasts for the current 14-15 year and up 3% for the 15-16 so called budget year, but the incomes of millionaires remain the same as forecast in January.

The only explanation we can think of is that somehow the governor made ambitious forecasts for the MHSA revenues in January that already accounted for the growth in incomes (since MHSA forecasts in January were substantially above previous estimates) but chose in January to be much more cautious for overall state revenues.

If and when we get a better explanation it will be provided.

Like most health and human service advocates we were disappointed that there were no major restorations of funding in specific programs- not even in the Mentally Ill Offender Crime Reduction Grants which we had believed would be a priority for the governor in expanding funds for health since it had proven its value in reducing recidivism. We expect legislators to propose increases in this and other programs not included in the governor’s May Revise.

The governor did acknowledge that there are some general fund revenues available; while not increasing programs that are part of the “safety net” he did propose a tax credit for the lowest income individuals and families with incomes under $13,000 that tops out at $2,300 for a family of three or more with income under $6,000 and will cost just under $400 million annually.

The budget includes funding for a cost of living increase for MediCal physical health managed care plans (which does not affect county behavioral health) and acknowledges that the broader responsibilities of health plans for mild/moderate mental health and autism and the expanded county alcohol and drug programs are expected to add $360 million in state costs in 2015-16.

There is also $61 million (from federal and foundation funds) to implement health homes which will include all adults with severe mental illnesses and provide coordination to support better physical health for these individuals. It will also provide better integration with alcohol and drug services and physical health for everyone through screening for behavioral health lead in primary care and coordinated “warm hand off” services for those who screen positive as this program is gradually implemented through the Section 1115 Waiver program expected to gain federal approval in October.

Consistent with his January budget the governor provides more debt relief including the final payment of all of the pre 2004 state mandate obligations to local government. This includes nearly $700 million dollars to counties with the AB 3632 program the largest of these mandates.   In most counties that money goes to the county general fund, but in a few counties the funding goes to mental health and there are also providers whose contracts withheld funds until the county was paid and who will benefit directly from this funding.

The May Revise presumes the courts will allow the federal government to proceed with implementing the President’s order on immigrants and includes $62 million to provide full-scope Medi-Cal coverage to immigrants granted deferred action and $5 million for the Department of Social Services to provide grants to non-profits to provide application assistance to undocumented immigrants eligible for deferred action.

In education the governor includes $10 million for the multi tiered mental health programs envisioned in CCCMHA sponsored AB 1025 (Thurmond) which can support pilot programs to replicate the successful Seneca model program to determine if the cost effectiveness achieved in that program in Oakland (and a similar program run by the Desert Mountain Special Education Local Plan Area (SELPA) in San Bernardino County) can be achieved in other localities through similar county and school partnerships. This funding should help the bill get enacted.

The budget also increase funding for affordable housing from $200 million annually to $400 million as part of the so called Cap and Trade program which is a fee on factories and gas and oil use that is mostly for energy and transportation.

These were the main budget changes we noticed in our initial review.

There are probably others of importance to community behavioral health and we will provide updates as we obtain more information.

April 2015 Blog – We Need Statewide Transparent and Consistent County Behavioral Health Budgets For Stakeholders

We Need Statewide Transparent and
Consistent County Behavioral Health
Budgets For Stakeholders

In light of state reports of 30% revenue increases
over two years

At the end of February fiscal consultant Mike Geiss did his annual report to the Financial Oversight Committee of the state Mental Health Services Oversight and Accountability Commission. That report  showed that over the two year period reflecting the 2014-15 and 2015-16 years the revenues projected to be available to CCCMHA_63_logocounties for behavioral health services increased by 30% – more than $1.5 Billion from what was available in 2013-14. About half of the growth comes from Proposition 63 (Mental Health Services Act or MHSA) funds for which charts show amounts by quarter by county.   About 1/3 is from increased federal funds as a result of the Affordable Care Act which is due to increased enrollment in MediCal and the fact that most new enrollees are adults whose coverage is completely paid with federal funds. The rest is from realignment and mostly from 2011 realignment with the state not yet having decided how to allocate the growth among counties. Continue reading April 2015 Blog – We Need Statewide Transparent and Consistent County Behavioral Health Budgets For Stakeholders

Rusty Selix – California Leader in Mental Health Policy Issues and Co-author of Proposition 63